Tenn. Comp. R. & Regs. 1200-08-37-.06 - SERVICES PROVIDED

(1) Each TBI residential home shall provide twenty-four (24) hour staffing coverage that is adequate to meet the needs of residents. This will include both the residences and the day service facility under separate license, if any. Staffing and clinical expertise should correspond to the residents being served. TBI residential home providers shall coordinate with primary care physicians, specialists, and other health care professionals as appropriate.

(2) Traumatic brain injury residential home providers shall provide community-based care for their residents in addition to residential care, as provided in the resident's plan of care. During weekdays, the residents shall be provided day services through a separate facility licensed by the state. On weekends, the residents shall participate in community activities, including, but not limited to, church attendance, visits to local parks, and other recreational activities of their choice or the choice of their family or legal representatives, as provided in the resident's plan of care.

(3) As an alternative to the licensing condition of off-site day services, a TBI residential home serving only private pay or private insurance residents may provide day services for the residents on site as part of the comprehensive services provided.

(4) Medical services in a TBI residential home, when needed, shall be provided by:

(a) Appropriately licensed staff of a TBI residential home;

(b) Appropriately licensed or qualified contractors of a TBI residential home;

(c) A licensed home care organization; or

(d) Another appropriately licensed entity.

(5) Standards for Medication Administration. A TBI residential home shall:

(a) Ensure that all drugs and biologicals shall be administered by a licensed professional operating within the scope of the professional license and according to the resident's plan of care; and

(b) Ensure that all medications are kept in a locked, central location, separate from medications of the staff.

(c) Self-administration of Medication. Residents must have a physician or nurse practitioner's written order of approval to self-medicate. Residents able to handle their own medical regimen may keep medications in their own room in a locked storage container.

(d) Injections. Subcutaneous, intramuscular, and intravenous injections may be self-administered by the resident or by a licensed professional operating within the scope of the professional license.

(6) A TBI residential home shall dispose of medications as follows:

(a) Upon discharge of a resident, unused prescription medication shall be released to the resident, the resident's family member, or the resident's legal representative, unless specifically prohibited by the attending physician.

(b) Upon death of a resident, unused prescription medication must be destroyed in the manner outlined and by the person(s) designated in the home's medication disposal policy, unless otherwise requested by the resident's family member or the resident's legal representative and accompanied by a written order by a physician. The home's medication disposal policy shall be written in accordance with current FDA or current DEA medication disposal guidelines.

(c) The home shall properly dispose of prescription medication administered by the home in accordance with the home's medication disposal policy.

(d) The home may dispose of prescription medication that is self-administered by the resident in accordance with the home's medication disposal policy or provide information to the resident's family member or the resident's legal representative regarding the proper method to dispose of the medication.

(e) If the resident is a hospice patient, hospice shall be responsible for disposing of the prescription medication upon death of the resident.

(7) A TBI residential home shall provide residential care to its residents as follows:

(a) Each TBI residential home shall provide each resident with at least the following residential care:

1. Protective care;

2. Safety when in the TBI residential home;

3. Daily awareness of the resident's whereabouts;

4. The ability and readiness to intervene if crises arise;

5. Room and board; and

6. Non-medical living assistance with activities of daily living.

(b) Laundry services. A TBI residential home shall:

1. Provide laundry equipment and supplies necessary for the cleaning of TBI residential home linens and residents' clothing;

2. Provide appropriate separate storage areas for soiled linens and residents' clothing; and

3. Maintain clean linens in sufficient quantity to provide for the needs of the residents. Linens shall be changed whenever necessary.

(c) Dietary services.

1. A TBI residential home provider shall provide three (3) nutritionally balanced meals per day or shall make arrangements for meals on an as needed basis. The food must be adapted to the habits, preferences and physical abilities of the residents. Additional nourishment and/or snacks shall be provided to residents with special dietary needs or upon request.

2. There shall be no more than fourteen (14) hours between the evening and morning meals.

3. All food served to the residents shall be of good quality and variety, sufficient quantity, attractive and at safe temperatures. Prepared foods shall be kept hot (140º F or above) or cold (41º F or less) as appropriate.

4. Meal planning and preparation shall take into consideration any special dietary needs of the resident, as prescribed by the resident's physician.

5. A TBI residential home provider shall designate a person responsible for the food service, including the purchasing of adequate food supplies and the maintenance of sanitary practices in good storage preparation and distribution. Sufficient arrangements or employees shall be maintained to cook and serve the food.

6. A TBI residential home provider may contract with an outside food management company if the company has a dietitian who serves the TBI residential home on a full-time, part-time, or consultant basis, and if the company maintains at least the minimum standards specified in this section while providing for constant liaison with the TBI residential home for recommendations on dietetic policies affecting resident treatment.

7. A TBI residential home shall have a current therapeutic diet manual approved by a dietitian readily available to all TBI residential home personnel.

8. Menus shall be planned one week in advance and posted in a location accessible to residents and families.

9. A TBI residential home shall:

(i) Provide sufficient food provision capabilities and dining space.

(ii) Maintain and properly store a forty-eight (48) hour food supply at all times.

(iii) Provide appropriate, properly-repaired equipment and utensils for cooking and serving food to serve all residents.

(iv) Maintain a clean and sanitary kitchen.

(v) Ensure employees shall wash and sanitize equipment, utensils and dishes after each use.

Notes

Tenn. Comp. R. & Regs. 1200-08-37-.06

Original rule filed October 28, 2015; effective 1/26/2016.

Authority: T.C.A. §§ 68-11-202, 68-11-206, 68-11-209, 68-11-270, 68-11-273, and 68-11-274.